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All ExamsCertified Billing and Coding Specialist (CBCS)Billing and Reimbursement

Billing and Reimbursement — Certified Billing and Coding Specialist (CBCS) Practice Test

Billing and ReimbursementQuestion 1 of 30

132 questions in this topic · 30 drawn at random this round

A biller reconciling a payment notices the RA shows an allowed amount lower than the billed charge, with the difference labeled a contractual adjustment. The biller should:

NHA CBCS — Medical Billing & Coding

Questions cover the four official NHA domains: the revenue cycle and regulatory compliance (HIPAA, fraud vs abuse), insurance eligibility and payer requirements (coordination of benefits, cost-sharing, prior authorization), coding and coding guidelines (ICD-10-CM Official Guidelines, CPT and HCPCS Level II concepts, modifiers, NCCI), and billing and reimbursement (CMS-1500, rejection vs denial, appeals). Grounded in public standards (HHS HIPAA, CMS, NUCC, ICD-10-CM Official Guidelines) — no copyrighted CPT descriptors are reproduced. The real exam is English-only; the multilingual explanations are a study aid.

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This Certified Billing and Coding Specialist (CBCS) Billing and Reimbursement practice set has 132 practice questions based on the official exam materials, each with an instant explanation.

Sample questions

Three questions from the Billing and Reimbursement bank with the correct answer and an explanation. The practice quiz above draws 30 questions at random from the same bank.

  1. The CMS-1500 claim form is used primarily to bill for which type of services?

    • Professional (physician and non-institutional provider) services — Correct answer
    • Inpatient hospital room-and-board charges
    • Institutional outpatient facility services
    • Hospital emergency department facility fees

    Explanation: Per NUCC and CMS, the CMS-1500 is the standard paper claim for professional/physician and other non-institutional provider services. Institutional/hospital facility charges (inpatient room-and-board, facility outpatient, ED facility fees) are billed on the UB-04 (CMS-1450). Keeping the two forms distinct is a core Domain 4 concept. (NHA CBCS Domain 4; NUCC CMS-1500)

    Handbook: Billing and Reimbursement — CMS-1500 & claim forms: CMS-1500 purpose (NHA CBCS Domain 4; NUCC/CMS)

  2. Which claim form is used by hospitals and other facilities to submit institutional (facility) charges?

    • UB-04 (CMS-1450) — Correct answer
    • CMS-1500
    • Form 837P
    • Advance Beneficiary Notice (ABN)

    Explanation: Per CMS, the UB-04 — also designated CMS-1450 — is the standard paper claim for institutional/facility charges such as hospital, skilled nursing, and outpatient facility services. The CMS-1500 is for professional services, and the ABN is a notice of non-coverage, not a claim form. (NHA CBCS Domain 4; CMS claim forms)

    Handbook: Billing and Reimbursement — CMS-1500 & claim forms: institutional claim form (NHA CBCS Domain 4; NUCC/CMS)

  3. Which organization maintains the CMS-1500 claim form?

    • The National Uniform Claim Committee (NUCC) — Correct answer
    • The American Medical Association (AMA)
    • The National Uniform Billing Committee (NUBC)
    • The Office of Inspector General (OIG)

    Explanation: Per CMS/NUCC, the National Uniform Claim Committee (NUCC) maintains the CMS-1500 professional claim form and its data-set standards. The National Uniform Billing Committee (NUBC) maintains the UB-04 institutional form. The AMA maintains CPT, and the OIG oversees fraud and abuse enforcement. (NHA CBCS Domain 4; NUCC)

    Handbook: Billing and Reimbursement — CMS-1500 & claim forms: NUCC maintenance (NHA CBCS Domain 4; NUCC)